• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.87-94
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• 2000

Objective : Various surgical approaches have been implemented to fulfill the ideal goals of treatment for cervical spondylotic lesions. Conventional approaches are represented by anterior approach with or without fusion and posterior approach. The authors has applied newly developed anterior cervical microforaminotomy for these lesions on minimally invasive basis. Materials and Method : Twenty-one patients, with cervical HIVD, or stenosis, or both, underwent anterior cervical microforaminotomy between March, 1998 and April, 1999. Fifteen patients underwent unilateral decompression, and 6 bilateral decompression via unilateral foraminotomy. Operation of one level was performed in 16 patients, 2 levels in 4 patients, and 3 in 1 patient. The foraminotomy was accomplished by resecting the uncovertebral joint. Through this hole, compressed nerve root was decompressed by removing the spondylotic spur or disc fragment, and diagonal removing of posterior osteophyte from foraminotomy site to begining of contralateral nerve root made spinal cord decompression. Results : The outcome was excellent in 17 patients(81%) and good in 4 patients(19%) based on Odom's criteria. No complication was encounterd, and average post-operation hospital stay was 3.7 days. Conclusions : These results indicate that anterior cervical microforaminotomy provide adequate neural decompression, minimum postoperative discomfort and fast recovery.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.87-94
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• 1999

Backgroud: We have performed the CT-guided celiac plexus block (CPB) using anterior approach to evaluate the safety and efficacy of the procedure and to determine the role of CT. Methods: CPB were done in 10 patients (5 men and 5 women: mean age, 58.1 years) with intractable upper abdominal pain due to terminal malignancy of the stomach (n=3), pancreas (n=4), gallbladder (n=2), and liver (n=1). To permit an anterior approach, patients lay supine on the CT scan table during the procedure. One 21-guage Chiba needle was placed just anterior to the diaphragmatic crus between the celiac and superior mesenteric arteries and 10~12 ml of dehydrated alcohol was injected. Degree of pain relief following the procedure was assessed and pain was graded on a numeric rating scale (NRS) from 0 to 10. Results: The results suggest a direct relation between the degree of celiac invasion and the response to the CPB. With CT guidance, it is possible for us to direct the needle into more accurate region, allowing alcohol to be deposited in specific ganglion area. Conclusions: CT-guided CPB using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT-guidance allowed precise needle placement and safe procedure. Careful classification of cases is important to predict the degree of pain relief using the grading system based on the degree of involvement of the celiac plexus.

• Advances in pediatric surgery
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• v.13 no.1
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• pp.76-80
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• 2007

The authors applied anterior sagittal transrectal apporach (ASTRA) for the repair of urethrovaginal fistula which developed after total repair of persistent cloaca. The patient had been diagnosed to have persistent cloaca, double uterus and double vagina, and received PSARP, excision of right-side uterus and vagina, and left vaginal switch operation at 22 months old. After operation, the patient admitted several times due to frequent urinary tract infection and ectopic stone formation in bladder and neovagina. Urethro-neovaginal fistula was confirmed by cystoscopy and corrected with ASTRA. Postoperative voiding cystourethrogram showed no fistula tract. ASTRA showed improved surgical field, minimized ureterocystic damage, and preserved perirectal nerve due to limited incision of rectum.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.39-42
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• 2016

Forehead osteomas are benign but can pose aesthetic and functional problems. These osteomas are resected via bicoronal or endoscopic approach. However, large osteomas cannot be removed via endoscopic approach, and bicoronal approach can result in damage to the supraorbital nerve with resultant numbness in the forehead. We present a new approach to resection of forehead osteomas, with access provided by an anterior hairline incision and subcutaneous dissection. Three patients underwent resection of the forehead osteoma through an anterior hairline incision. The dissection was carried in the subcutaneous plane, and the frontalis muscle and periosteum were divided parallel to the course of supraorbital nerve. The resulting bony defect was re-contoured using $Medpor^{(R)}$. All three patients recovered without any postoperative infection or complication and symptoms. Scalp sensory was preserved. Aesthetic outcomes were satisfactory. Patients remain free of recurrence for 12 months of follow up. The anterior hair line approach with subcutaneous dissection is an effective method for removal of forehead osteoma, since it offers broad visualization and hides the scar in the hairline. In addition, the dissection in the subcutaneous plane avoids inadvertent injury to the deep nerve branches and helps to maintains scalp sensation.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.450-454
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• 2006

The incidence of vertebral artery injury during the anterior approach to the cervical spine is rare, but potentially lethal. The authors describe two cases of vertebral artery injury during anterior cervical decompression surgery. In the first case, infection was the cause of the vertebral artery injury. During aggressive irrigation and pus drainage, massive bleeding was encountered, and intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm. In the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. After intraoperative control of bleeding, the patient was referred to our hospital, and a pseudoaneurysm was detected by angiography four days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurological sequelae. Urgent vertebral angiography, following intraoperative control of bleeding by hemostatic compression in cases of vertebral artery injury during anterior cervical decompression, should be performed to avoid life-threatening complications. Prompt recognition of pseudoaneurysm is mandatory, and endovascular treatment can be life saving.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.290-294
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• 2023

Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.383-386
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• 2014

Objective : Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression. Methods : We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature. Results : The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up. Conclusion : Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.166-169
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• 2017

The goal of auricular cartilage harvest is to obtain a sufficient amount for reconstruction and to minimize the change in ear shape. The cartilage can be harvested by a posterior or anterior approach, and each method has advantages and disadvantages. The posterior approach presents the advantage of scar concealment, but there are limits to the amount of cymba cartilage that may be harvested. In contrast, the anterior approach may cause a noticeable scar. However, as cartilage is collected, the anterior approach provides a view that facilitates the preservation ear structure. In addition, it is possible to obtain a greater amount of cartilage. From January 2014 to December 2015, we harvested auricular cartilage graft material in 17 patients. To prevent the development of trapdoor scars or linear scar contracture, short incisions were made on the superior border of the cymba and cavum. Two small and narrow incisions were made, resulting in suboptimal exposure of the surgical site, which heightens the potential for damaging the cartilage when using existing tools. To minimize this, the authors used a newly invented ball-type elevator. All patients recovered without complications after surgery and reported satisfaction with the shape of the ear.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.179-186
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• 2012

Objective : Even in the patients with neurologically good outcome after intracranial aneurysm surgery, their perception of health is an important outcome issue. This study aimed to investigate the quality of life (QOL) and its predictors of patients who had a good outcome following anterior circulation aneurysm surgery as using the World Health Organization Quality of Life instrument-Korean version. Methods : We treated 280 patients with 290 intracranial aneurysms for 2 years. This questionnaire was taken and validated by 99 patients whose Glasgow Outcome Scale score was 4 and more and Global deterioration scale 3 and less at 6 months after the operation, and 85 normal persons. Each domain and facet was compared between the two groups, and a subgroup analysis was performed on the QOL values and hospital expenses of the aneurysm patients according to the type of craniotomy, approach, bleeding of the aneurysm and brain injury. Results : Aneurysm patients showed a lower quality of life compared with control patients in level of independence, psychological, environmental, and spiritual domains. In the environmental domain, there were significant intergroup differences according to the type of craniotomy and the surgical approach used on the patients (p<0.05). The hospital charges were also significantly different according to the type of craniotomy (p<0.05). Conclusion : Despite good neurological status, patients surgically treated for anterior circulation aneurysm have a low quality of life. The craniotomy size may affect the QOL of patients who underwent an anterior circulation aneurysm surgery and exhibited a good outcome.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.342-345
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• 2007

The azygos anterior cerebral artery, a rare anomaly in the circle of Willis in which only a single vessel supplies the medial aspects of both anterior cerebral hemispheres, is closely associated with saccular aneurysms. We present three cases of azygos anterior cerebral artery aneurysms among the 781 cerebral aneurysms surgically treated at our institution in an 11-year period. These three cases all involved elderly women who presented with subarachnoid hemorrhage. Conventional cerebral angiography and CT angiography revealed small saccular aneurysms at the distal ends of the azygos anterior cerebral arteries. These aneurysms were clipped successfully using a bifrontal interhemispheric approach. Hence, the pathogenesis of these particular aneurysms relating to hemodynamic change, associated anomalies, and surgical pitfalls is discussed with review of literature.